Saturday, 2 August 2014

GUIDELINES FOR LYME DISEASE

New Standard of Care Guidelines for Treating Lyme and Other Tick-borne Illnesses Released by International Lyme and Associated Diseases Society (ILADS)

Bethesda, Maryland, July 31, 2014
How doctors treat patients with suspected Lyme infections needs to change so as to avoid potential long term illness and suffering.  To that end, the International Lyme and Associated Diseases Society (ILADS) today released updated guidelines for the treatment of Lyme and other tick borne infections which call on physicians to provide evidence-based, patient-centered care for those with Lyme disease.
 
Published in the August 2014 edition of the journal Expert Review of Anti-infective Therapythe new guidelines, titled: Evidence Assessments and Guideline Recommendations in Lyme disease: The Clinical Management of Known Tick Bites, Erythema Migrans Rashes and Persistent Disease, say current antibiotic protocols used by many physicians to prevent or treat Lyme disease are inadequate, leading to an increased risk of Lyme disease developing into a chronic illness.
 
“Chronic manifestations of Lyme disease can continue long after other markers of the disease, such as the erythema migrans rash, have resolved,” said Daniel Cameron, M.D., M.P.H., and lead author. “Understanding this reality underlies the recommendation for careful follow-up to determine which individuals with Lyme disease could benefit from additional antibiotic therapy.”
 
 ILADS is the first organization to issue guidelines on Lyme disease which comply with the standards set by the Institute of Medicine for developing trustworthy protocols. The document provides a rigorous review of the pertinent medical literature and contains recommendations for Lyme disease treatment based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process. This review format is used by other well-respected medical organizations including the Cochrane Collaboration and the World Health Organization.
 
ILADS’ GRADE-based analyses discovered research studies guiding current treatment protocols were of very low quality; and, the regimens based on these randomized controlled trials often failed.  “For this reason, we moved away from designating a fixed duration for antibiotic therapy for tick borne illnesses and instead encourage clinicians to tailor therapy based on the patient’s response to treatment,” noted Dr. Cameron.
 
“We not only recommend clinicians perform a deliberate and individualized assessment of the potential risks and benefits of various treatment options before making their initial selection,”  said guidelines coauthor Elizabeth Maloney, M.D., “we also recommend careful follow-up. Monitoring a patient allows clinicians to adjust therapy as circumstances evolve. This more selective approach should reduce the risk of inadequate treatment giving rise to a chronic illness,” added Dr. Maloney.
 
The guidelines encourage shared medical decision making and taking patient values into consideration. Lorraine Johnson, J.D., MBA, a coauthor and Executive Director of LymeDisease.org, noted, “A lot of the treatment decisions in Lyme disease depend on trade-offs. How sick is the patient? How invasive is the treatment? What is valued by the patient? Patients need to understand the risks and benefits of treatment options to make informed medical choices,” added Ms. Johnson. “These guidelines provide that information.”
 
 
 
ILADS is a nonprofit, international, multidisciplinary medical society dedicated to the appropriate diagnosis and treatment of Lyme and associated diseases.
 
 
For more information:
 
www.ilads.org
 
Facebook
Further article on Lyme Disease.org 
ABSTRACTSection:
Next section
Evidence-based guidelines for the management of patients with Lyme disease were developed by the International Lyme and Associated Diseases Society (ILADS). The guidelines address three clinical questions – the usefulness of antibiotic prophylaxis for known tick bites, the effectiveness of erythema migrans treatment and the role of antibiotic retreatment in patients with persistent manifestations of Lyme disease. Healthcare providers who evaluate and manage patients with Lyme disease are the intended users of the new ILADS guidelines, which replace those issued in 2004 (Exp Rev Anti-infect Ther 2004;2:S1–13). These clinical practice guidelines are intended to assist clinicians by presenting evidence-based treatment recommendations, which follow the Grading of Recommendations Assessment, Development and Evaluation system. ILADS guidelines are not intended to be the sole source of guidance in managing Lyme disease and they should not be viewed as a substitute for clinical judgment nor used to establish treatment protocols.

Monday, 21 July 2014

ALZHEIMER CAUSED BY SPIROCHETES - SYPHILIS, BORRELIOSIS (LYME DISEASE), DENTAL PATHOGENS




Alzheimer Borreliosis Lecture London June 4 2014
Dr Alan MacDonald 


Published on Jul 17, 2014
Infection Induced Human Dementias are briefly reviewed,.Tertiary Syphilitic 
Dementia ( General Paresis) is reviewed and comparisons with Tertiary Spirochetal Human infections , dementing types. (Leptospirosis-NEJM 2014, Treponema pallidum, Borrelia burgdorferi family of spirochetes, and other Oral Treponemes.
The Conclusion Formulation by Dr. Alan MacDonald, MD is that
Alzheimer's disease of the Subtype caused by Tertiary Neuroborreliosis
demonstrates Evidence by Borrelia specific DNA Probe analysis and by 
Microbiologic cultures of Autopsy Alzheimer's Brain tissues producing
live Borrelia in pure culture, that Alzheimer's of the Tertiary Borreliosis type
is a infectious disease. The Plaques in such cases are Borrelia biofilm communities.
Granular Vacuolar lesions of the Hippocampus are granular borrelia
which contain Borrelia DNA and which Bind Borrelia specific DNA tissue
probes with In Situ DNA Hybridization in Autopsy studies.
The Borrelia infection subtype of Alzheimer's, in like manner with with
Treponema pallidum induced Dementia in late disease has the potential to to
be cured by antibiotic therapies. 

The above lecture was given at the Inaugural Meeting of the Spirochetal Alzheimer Association link here

Friday, 18 July 2014

BORRELIA MIYAMOTOI FOUND IN TICKS IN ENGLAND

Borrelia miyamotoi in host-seeking Ixodes ricinus ticks in England.

Link to the paper on Pubmed here  

 2014 Jul 14:1-9. [Epub ahead of print]

Borrelia miyamotoi in host-seeking Ixodes ricinus ticks in England.

Abstract

SUMMARY This paper reports the first detection of Borrelia miyamotoi in UK Ixodes ricinus ticks. It also reports on the presence and infection rates of I. ricinus for a number of other tick-borne pathogens of public health importance. Ticks from seven regions in southern England were screened for B. miyamotoi, Borrelia burgdorferi sensu lato (s.l.), Anaplasma phagocytophilum and Neoehrlichia mikurensis using qPCR. A total of 954 I. ricinus ticks were tested, 40 were positive for B. burgdorferi s.l., 22 positive for A. phagocytophilum and three positive for B. miyamotoi, with no N. mikurensis detected. The three positive B. miyamotoi ticks came from three geographically distinct areas, suggesting a widespread distribution, and from two separate years, suggesting some degree of endemicity. Understanding the prevalence of Borrelia and other tick-borne pathogens in ticks is crucial for locating high-risk areas of disease transmission.
PMID:
 
25017971
 
[PubMed - as supplied by publisher] 
  

Borrelia miyamotoi found in ticks in England is of significant importance because of problems over testing

Lyme Disease Action  discusses Borrelia Miyamotoi in this article here 

Illness following Tick bites may not always be identified by blood tests, essentially 
doctors may have to make a clinical diagnosis and treat empirically 

An excellent source of information for clinicians and patients is Lyme Disease Action 

Wednesday, 16 July 2014

LYME BORRELIOSIS COMPLEX - DR JEMSEK





Dr. Joseph G. Jemsek, MD, FACP, AAHIVS was a Keynote Speaker at the Partners Against Lyme and Tick Associated Diseases' Inaugural Forum on October 5th, 2013.

Inspirational speech - Dr Jemsek's journey treating Lyme Disease 

Dr Jemsek came to London in June and presented at the London Symposium on Tick borne disease to an audience of doctors, researchers and vets.


An earlier post Dr Jemsek discussing the Physician Training Program link here 

and Dr Jemsek  'Speak the truth speech'  link here 

Monday, 14 July 2014

TICK-BORNE PATHOGENS - AN OPEN LETTER TO MARTIN ANDERSSON AND RICHARD BIRTLES

An Open Letter to Martin Andersson and Richard Birtles.

Your presentations at the recent Lyme Disease Action conference at the University of Surrey were particularly impressive and obviously the results of countless hours of effort from you and your co-workers. The information regarding the transmission pathways of tick-borne pathogens highlighted the differences of risk to human health from the different species of ticks, and help define optimum strategies for disease prevention. It also demonstrated the variability of tick infection rates on geographic macro and micro scales. Of great interest was the ingenious study of forest enclosures and tick infection rates within and outside the barriers. Deer population size was a driver of tick populations, and rodents a driver for tick infection rates. This suggests that areas with large populations of mammals that provide the final feed for adult female ticks along with high populations of rodents, will have high numbers of infected ticks.

The study of Candidatus Neoehrlichia mikurensis is important in highlighting the fact that ticks carry many different microbes, and new species are being discovered all the time. More than 18 distinct species of Borrelia bacteria have been identified since Willy Burgdorfer first identified the cause of Lyme disease in the early 1980’s. There can be long delays between identification of an organism and general recognition as a disease causing pathogen. It is normal to describe incidence of disease based on national or regional boundaries, however it was well demonstrated in the presentation that absence of reported cases does not mean absence of the disease, and the fact that until you look you will not find. Has the genetic divergence seen in China compared to that exhibited in Europe been used to estimate the length of time that Neoehrlichia has been present in these regions?

Both presentations highlight the fact that ticks do not recognise boundaries marked on maps. It is whether the ecological conditions exist at a specific location that drives the occurrence of infected ticks. Fragmentation of woodland created by urban expansion and people living adjacent to woodlands, parkland and other tick habitat results in large numbers of people and their companion animals permanently living in close proximity to ticks. There could be a higher risk living at 201 Sunnyside Avenue with 2 dogs than an occasional visit to our magnificent countryside.

Clinicians officially have 10 minutes to decide what ails a person, and if Lyme is suspected then it is convenient to enquire whether the person visited a hot spot defined regionally such as, The New Forest, or Dartmoor or Thetford Forest. It may be more relevant to ask; do you live or play near woodland or areas of natural beauty. This is not an easy option to implement when we are so conditioned to arbitrary lines marked on maps. Can a method other than the use of title specific regions be developed to help clinicians assess the risk of infection? Or should the concept of “hot spots” be abandoned and replaced by a greater emphasis on clinical symptoms?

It is hard work and scientific data gathering and analysis as demonstrated by you, that will help educate current and future generations and reduce or avoid the often devastating and sometimes fatal effects of tick-borne diseases.

Michael Cook
Highcliffe
Dorset

Friday, 11 July 2014

DR STEPHEN BARTHOLD LYME DISEASE PERSISTENCE





Dr Stephen Barthold interview on Lyme disease From CBC Ticked Off The Mystery of Lyme Disease - expert interviews found on the right hand side of this link here

Persistence of Lyme Disease bacteria has been much in the news recently with CDC/NIH Webinar posted earlier here 

The previous post to this on persisters here

Another interesting presentation from Dr Barthold can be found here 

Friday, 4 July 2014

FDA APPROVED DRUGS FOR PERSISTER CELLS - LYME DISEASE- FROM JOHNS HOPKINS

Citation: Emerging Microbes & Infections (2014) 3, e49; doi:10.1038/emi.2014.53
Published online 2 July 2014

Identification of novel activity against Borrelia burgdorferi persisters using an FDA approved drug library

OPEN

Jie Feng1, Ting Wang1, Wanliang Shi1, Shuo Zhang1, David Sullivan1, Paul G Auwaerter2 and Ying Zhang1
1Department of Molecular Microbiology and Immunology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
  1. 2Fisher Center for Environmental Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA
Correspondence: Y Zhang, E-mail: yzhang@jhsph.edu
Received 17 April 2014; Revised 30 May 2014; Accepted 3 June 2014

Link to the article here and interesting table of activity against Borrelia burgdorferi persisters here 

ABSTRACT

Although antibiotic treatment for Lyme disease is effective in the majority of cases, especially during the early phase of the disease, a minority of patients suffer from post-treatment Lyme disease syndrome (PTLDS). It is unclear what mechanisms drive this problem, and although slow or ineffective killing of Borrelia burgdorferi has been suggested as an explanation, there is a lack of evidence that viable organisms are present in PTLDS. Although not a clinical surrogate, insight may be gained by examining stationary-phase in vitro Borrelia burgdorferi persisters that survive treatment with the antibiotics doxycycline and amoxicillin. To identify drug candidates that can eliminate B. burgdorferi persisters more effectively, we screened an Food and Drug Administration (FDA)-approved drug library consisting of 1524 compounds against stationary-phase B. burgdorferi by using a newly developed high throughput SYBR Green I/propidium iodide (PI) assay. We identified 165 agents approved for use in other disease conditions that had more activity than doxycycline and amoxicillin against B. burgdorferi persisters. The top 27 drug candidates from the 165 hits were confirmed to have higher anti-persister activity than the current frontline antibiotics. Among the top 27 confirmed drug candidates from the 165 hits, daptomycin, clofazimine, carbomycin, sulfa drugs (e.g., sulfamethoxazole), and certain cephalosporins (e.g. cefoperazone) had the highest anti-persister activity. In addition, some drug candidates, such as daptomycin and clofazimine (which had the highest activity against non-growing persisters), had relatively poor activity or a high minimal inhibitory concentration (MIC) against growing B. burgdorferi. Our findings may have implications for the development of a more effective treatment for Lyme disease and for the relief of long-term symptoms that afflict some Lyme disease patients.

Keywords: 

Borrelia burgdorferi; drug discovery; FDA approved drug library; persisters; SYBR Green I

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Interesting discussion on this important paper on Lymenet Europe forum thanks to Camp Other 
'Lyme Research Alliance has been funding Dr. Kim Lewis' team to do research on Borrelia burgdorferi persister cells and to find a treatment that will kill persisters (either a new antibiotic or antibiotic and an additional drug/metabolite which awakens dormant cells).

Today, an open access paper has been published by Nature by both Auwaerter (who has been adamant that people cannot get persistent infections with Lyme disease) and Zhang, who has worked on persister cells and published in Nature prior to this about them. Zhang and Lewis have done persister research together.

In an interesting turn of events, Auwaerter and Zhang and co. have been doing research on FDA-approved drugs already in their database which may work on Borrelia persister cells. While Auwaerter issues his usual caveats that there isn't established evidence of persistent infection in people with post treatment Lyme disease/chronic Lyme disease, it is notable that he would be working on this kind of research and write about the uncertainties concerning Lyme disease.' 
http://www.lymeneteurope.org/forum/viewtopic.php?f=5&t=5419

An excellent explanation about the difference between antibiotic resistance and persister cells found on Camp Other blog here